WC in AL for shoulder injury...story & questions (long)

[SmokyShadow]

We live in and filed in Alabama. Injury happened in Salt Lake City, Utah.

My husband Barry has the injury. Right rotator cuff torn over 90% and bicep tendon torn over 95%.

August 11, 2009. He was a truck driver, trying to lower the landing gear on a trailer but it wouldn't shift into low gear plus it had the wrong handle. Handle slipped off when he was pushing on it. He fell into/again the trailer, handle and ground.

Company wouldn't send him to a doctor, made him drive from SLC, Utah to Ga, drop & hook trailers, drop again in Birmingham, AL before he came home to Harpersville, AL. He had a partner with him but he still had to help drive. Plus the transmission was messed up - truck had already been in the shop twice - and was very difficult to shift even before the injury. When he needed to shift he held the steering wheel with his right hand and reached across with his left hand.

Got hurt around 1am on a Tuesday morning, got him home late Thursday and he still didn't see the doctor until the following week. First couple of visits said it was just sprained even though he insisted it was worse. Finally got a MRI/Arthrogram which showed how bad it really was. He kept wanting his upper arm tested as well, but to this day the doctors still refuse to consider that there may have been damage done directly to the bicep or other soft tissues in his arm.

He was scheduled for surgery Sept. 1, 2009 which went well except during the "block" before the surgery. He was told it would hurt some but he said it was nearly excruciating. Starting that evening after he got home, he started having spasms in his hand. Not often, maybe 2 or 3 a week, but he didn't have them before that day. He also started swelling on his right side...arm, hand, leg and foot. Not the left. It hasn't stopped since and the doctors won't say what caused it or admit that it was related to the surgery.

The 2nd day after the surgery when he stood up, he got dizzy and fell back into the chair. His injured arm came down across the arm of the chair and tore some of the tissue lose again. Doctor was informed but decided to hope for the best since they couldn't go back in right away and had him going to physical therapy even though his shoulder had been reinjured.

Doctor decided to go back in for repairs. Second surgery Oct. 6, 2009. Much, much worse - very traumatic - than anything else before. Within a couple of hours of the surgery he started complaining of pain and thus began over two weeks of no sleep (and I do mean NO sleep) day or night and excruciating pain. Within the first week of this surgery they started him back on physical therapy. The only thing he had for pain was lortab-10 and zanaflex. He took them and rotated maximum doseages of tylenol and motrin, but it did nothing for a while and even now only barely takes the edge off of the pain. I honestly believe he was teetering on the brink of insanity when he couldn't sleep.

He had been going to physical therapy two, sometimes, three times weekly. Performed all of his exercises at home as directed. He had very limited motion in his arm and even the physical therapist sent him back to the doctor twice because she felt something else was wrong with his arm. When she tried to raise his arm she could feel resistance that shouldn't have been there. He's developed a couple of knots on his shoulder and he was still experienceing pain in his upper arm as well. She also reported that his shoulder blade is frozen, too.

After each surgery they said within four months he could be released to light duty if the employer had any, otherwise it would be at least six months before he could go back to full duty. The doctor never released him for work, light or otherwise. He went to his monthly dr. appt in January and the doc asked if he wanted another surgery or a test to see why his arm wasn't making progress. Barry was surprised but requested a test. Five weeks (Feb. 2010) later he had another MRI/Arthrogram. The results showed two more small tears. The doc said that Barry was at MMI and he scheduled a FCE which took place less than two weeks ago. We just got his results in the mail today..."The upper right extremity impairment estimate due to abnormal Range of Movement is 16%. The whole-person impairment estimate conversion is 10%. This examiner recommends a whole-person impairment estimate of 10%."

Of course wc stopped the checks when the doctor said the magic word...MMI. We contacted an attorney after his FCE (which was joke) and now we're waiting to consult with the doc again for a final IR. WC is supposed to make an offer after they get the final IR.

Questions:

Has anyone here had the "block," and if so, what was your experience with it?
The doctor has not tested his upper arm to what, if any, injuries it might have. In your opinion/experience, would it be better to push for a second opinion? What about a second, independent FCE - if he has additional injuries in that arm would it give a higher IR? I'm thinking it would be better to grab the offer if it's "reasonable" and use his insurance (or medical for life from wc) to take care of his arm afterwards.
Can an impairment rating be changed after a case is settled, if he is found to have additional, previously unidentified injuries?
Is a 10% whole-person impairment rating good for this injury?
What does an "invalid" result mean on a test such as the "Jamar bell curve?"

Ok, I think I have unwound a little now. We're both on the edge of a nervous breakdown. We thought we had a few more months before dealing with an MMI and its' implications.

[inpainokla]

sounds like they were doing all they could to fix his arm/shoulder..what other treatment would you suggest fo him??loratab 10's are a very strong narcotic i was taking them for over a year..i had back surgery and did very well with them along with tramadol,gabapentin.baclofen,lyrica..all that good stuff..how is he doing now that hes reached mmi??i dont really know if the rating is fair but im sure there we be ppl along to share there info with ya that prolly have similar horror stories..welcome to the forum..there are great pll here that know a whole lot about the system and its rules

[capricorn]

Hi Smokey and welcome...can't help with it all but will try what Ican...I had the nerve block when I had my shoulder surgery....I believe one of the risks is nerve damage.....I thought is was scary and did n't want it but my surgeon persisted because he was afraid to put me to sleep due to my having asthma attacks during surgery. The nerve block itself hurt like all get out.....I was numb for 24 hours.....didn't know where my hand was..had to keep feeling for it...
Post-surgery....my shoulder is worse than before.....I had the rotator cuff tear and decrompression surgery but did not have the bicep teat which still amazes me since that's where 75% of my pain is. PT after the surgery caused me alot of problems since I had a very rough PT. I also froze 12 weeks later which I might say is one of the most excruciating pains I have ever felt. Iused to fall asleep with ice on me until it was dripping and my husband would take it off...I was up immediately.....I have yet to find any medication that helps with the pain except Toradol which they will only prescribe after surgery for maybe 5 days. No narcotic has ever gotten rid of the pain...mysurgery was almost 3 years ago and I still can barely lift my tea cup and can't raise my arm totally...I too did all excercises at home, I still do pullys.

Yes ...he can have an independent FCE....surprised your attorney is requesting one....16% isn't bad in comparison to mine which Ibelive wasonly 10%...I injured 5 body parts at the same time so that might be why...No and IR can't be changed after settlement....once settlement if it is a Compromise and Release occurs and is signed by all including the Judge the case is closed....you would need a damn good attorney working on this to change it.....My last MRI has shown another tear and many more problems which I am told is normal from the after effects of the surgery I had....the original surgery is done andhealed correctly...thisis from my second opinion....MMI means nothing else can be done..not that he is OK>


I hope I helped a little... Sundays are a little slow here....I'm sure by tomorrow more will be along with there advise.

[Cycler]

The Percentage of impairment the Dr gave is too low if he used the AMA Guides 5th or 6th edition. While range of motion may give that figure there is another table that is used when there is also muscle damage causing weakness, table 16-35 or 37, that assesses specific muscle weakness and since there are four rotator cuff muscles there is potential for a lot more impairment percentage beyond s just range of motion loss. Many Dr.s do not do these exams correctly. I imagine your atty will send you a Dr. of his choosing for an exam also and will find a higher percentage. Workers comp is like a litigious process so there are always dueling experts, just like a lawsuit.

There seems to be a clinical indication for a nerve test to the arm though based on your story of what sounds like an inter-scalene block (side of the neck is where the needle is placed for the block).

Much can go wrong there. Here's a few links that explain the procedure in detail and two studies on the complication rates.

http://www.ncbi.nlm.nih.gov/pubmed/11605927
http://www.nysora.com/peripheral_nerve_b...Block.html
http://smj.sma.org.sg/2004/2004smj9.pdf

These matters should also be discussed with your atty as additional damage may have been done to the nerves and vascular bundle during anesthesia. He wouldn't be the first.

[capricorn]

Cycelr thank you for the exact name of the block...I had 5 injections in the side of my neck tha t hurt like all hell.....I had no pain after surgery for 24 hours and no permanent damage but I would also never do it again....I was away through most of it....they had to do it open becaus ethere was alot of mess in there.


I should have explained that the Dr. who did my IR was a court appointed Dr. so my attorney's hands were tied....he couldn't order another.....This Dr. does most in PA and takes about 5 minutes to do it...with 5 injured body parts I knew he was off target.. I also have muscle damage that went ignored by Dr.'s and PT's. The majority of my pain is in my bicep and shoulder itself.

[Bad Boy Bad Boy]

http://journals.lww.com/ajpmr/Abstract/1...ned.5.aspx

http://www.ispub.com/ostia/index.php?xml...rength.xml

I see you mentioned 2 or 3 weeks he went through with no sleep. Gosh, I do remember them days, I went through more then 1 year with no sleep, only fell asleep when I passed out from exhaustion, or when I went to PT, my doctor had given me a shot to knock me out, let me sleep 3 or 4 hours on a PT table, then when I woke up performed my PT.

[Cycler]

What are those references for ?

Bad Boy Bad Boy Wrote:http://journals.lww.com/ajpmr/Abstract/1...ned.5.aspx

http://www.ispub.com/ostia/index.php?xml...rength.xml

I see you mentioned 2 or 3 weeks he went through with no sleep. Gosh, I do remember them days, I went through more then 1 year with no sleep, only fell asleep when I passed out from exhaustion, or when I went to PT, my doctor had given me a shot to knock me out, let me sleep 3 or 4 hours on a PT table, then when I woke up performed my PT.

[Bad Boy Bad Boy]

References for;

Jamar bell curve testing...

[Cycler]

ahh, well the test itself is not used to establish an impairment percentage under AMA Guides but can be used as a validity test in the Rapid Grip Exchange test.

[Bad Boy Bad Boy]

Cycler, I do know that. I was just giving them information as to what the test is. As they are not the injured worker, I thought knowing what the test is all about, would help them figure out their question.

(((What does an "invalid" result mean on a test such as the "Jamar bell curve?" )))

But, all in all, a invalid test result mostly means, the person wasn't able to perform it, or couldn't perform it.